Provider Demographics
NPI:1760601850
Name:PRESTON TAYLOR COMMUNITY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:PRESTON TAYLOR COMMUNITY HEALTH CENTERS INC
Other - Org Name:PRESTON TAYLOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXEC OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-265-0312
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-0188
Mailing Address - Country:US
Mailing Address - Phone:304-265-7400
Mailing Address - Fax:304-265-7401
Practice Address - Street 1:25 W BLUEMONT ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1242
Practice Address - Country:US
Practice Address - Phone:304-265-7400
Practice Address - Fax:304-265-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05523533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111639OtherPK
WV3810008948Medicaid